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KEYWORDS:phacoemulsification; continuous curvilinear capsulorhexis; complication

Yang GY, Huang YL, Wu ZF. Controlled continuous curvilinear capsulorhexis in short axial length and shallow anterior chamber eyes.

INTRODUCTION

Continuous curvilinear capsulorhexis (CCC) is a standard procedure in the surgery of phacoemulsification.Successful CCC is vital for the completion of the following manipulations.It can reduce the complications of posterior capsule rupture(PCR),vitreous loss, etc. In short axial length and shallow anterior chamber eyes,especially eyes with angleª²closure glaucoma(ACG), narrow operation space for capsulorhexis, and greater pressure gradient behind the crystalline lens can lead to great difficulty and low success rate of CCC[1]. By filling the anterior chamber with viscoelastic and aspirating liquid cortex,a controlled capsulorhexis can facilitate[2]. Another technique of direct puncture capsulorhexis to prevent anterior chamber shallowing and peripheral capsular tearing has also been introduced[3,4]. After filling the anterior chamber with a viscoelastic agent to decompress the lens, the capsulorhexis is completed with an endoilluminator as an oblique source of illumination. This technique allows controlled capsulorhexis in eyes with intumescent cataract[5]. In the present study, we used a new controlled CCC technique and compared the efficacy of this technique with that of the routine CCC.

PATIENTS AND METHODS

Sixtyª²eight patients(68 eyes) having phacoemulsification and intraocular lens(IOL) implantation or combined with trabeculectomy from January to December 2008 were included in the study.The procedures were done by one surgeon. Thirtyª²seven were male and thirtyª²one were female. The average age was 70.5¡À8.7 years. The axial length was 19.7¡À1.2mm. The anterior chamber axis depth was less than or equal to 2.5mm. The routine CCC and bimanual CCC technique were used in thirtyª²two cases(32 eyes) and thirtyª²six cases(36 eyes), respectively.

The routine CCC was performed with capsulorhexis forceps alone after injecting viscoelastic agent into anterior chamber. In controlled CCC technique after injecting viscoelastic device into anterior chamber a chopper with spade tip was inserted through a corneal side port at 2¡Ã00. The central anterior capsule was pressed with the chopper tip to form a foveation appearance. Capsulorhexis forceps was inserted into anterior chamber through the main clear corneal incision at 11¡Ã00. Anterior capsule was directly punctured with capsulorhexis forceps at 9¡Ã00. CCC was performed from 9¡Ã00 to 2¡Ã00 clockwisely and from 9¡Ã00 to 2¡Ã00 counterclockwisely. During CCC procedure the anterior capsule was continuously pressed to maintain the foveation form. Mannitol was preoperatively used intravenously to dehydrate the vitreous if necessary.

RESULTS Ò½.ѧ.È«.ÔÚ.Ïßwww.lindalemus.com

The axial length and anterior chamber axis depth of two groups were shown in Table 1. The axial length and anterior chamber axis depth were not statistically different between two groups. In the routine group the procedure of CCC were finished smoothly in 17 cases(53.13%). The capsulorhexis edge teared peripherally and needed to be cut by scissors before finishing the CCC in 15 cases (46.87%, among which the capsulorhexis edge tearing peripherally involved the posterior capsule during the surgery in 3 cases (9.38%). In the controlled group the CCC were finished successfully in 31 cases(86.11%). The capsulorhexis edge teared peripherally in 5 cases (13.89%), none of which had involved posterior capsule during the process of surgery. The complication of zonular fibers injury and lens dislocation had not occurred.Table 1The axial length and anterior chamber axis depth of two groups(mm)Figure 1The force exerted upon the lens anterior capsule in routine CCC

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